Therapeutic Fit: What to Look For

Counsellors are talking a lot more about the value of the therapeutic fit these days and I’m glad. I’ve noticed an increasing emphasis on the value of the fit, or what some might call “rapport,” “comfort” or a counsellor who “gets it.” Counsellors also refer to fit as “he therapeutic alliance” or the “therapy relationship”.

The research also supports why the fit is key: over and over metanalyses of the literature show how important the therapy alliance is in determining counselling success.

Important Factors in Assessing Fit

What is fit, exactly? Fit encompasses a number of things and one constellation of factors, which is so right for one person, may not be for another. We are all unique people, after all.

But there are some important components to choose from when assessing therapeutic fit:

Comfort – Do I feel at ease in the counsellor’s presence?  Or at ease enough to continue, if counselling in and of itself freaks me out? Is the counsellor’s office environment one that feels secure and calming?  It’s good to look beyond the nice furniture, but if you have a bad back and the couch is uncomfortable, you probably won’t be able to relax!

Do I feel the absence of judgement from the therapist or do I worry less than I usually do about being judged?  Do I feel respected?

Personality – What do I like in a counsellor? Kindness? Irreverence? Calm? Grittiness? [insert here]? You get the point.

Therapy Style – Structured, unstructured, or something in between? Interactive? More passive? Do I long for feedback or want to come to my own conclusions?

Therapy Method – Do I have a particular therapy method in mind? Have I come for a particular method of counselling that I’m determined will help me? One that I’ve heard about but want to know more about? A therapy that’s worked in the past?

Experience – Is the counsellor experienced with the concerns I’m seeking help for? Or, am I open to them learning along the way if I think the fit is otherwise good?

Professionalism – Does the counsellor return calls and emails? Show up on time? Are they clear about their prices? Does he or she have upfront policies for their practice that I can view beforehand and that I can consent to?  If not, find another counsellor!  It is not good to set yourself up for a counselling arrangement that you cannot live with, or one you know nothing about.

Therapy Focus – Do my counsellor and I agree with the focus of therapy? Or, am I identifying an area that the counsellor disagrees with, or are they focusing on something I don’t find relevant? While it’s within a counsellor’s job description to make observations or, in some cases, point things out that clients may not be aware of, if there is not a fundamental agreement about the focus of therapy, there is likely a power struggle in the future.  Usually time for a new counsellor, unless the struggle can be addressed to your satisfaction.

Feedback – Am I comfortable raising issues of concern about the counsellor or the counselling itself with the therapist?  Are they receptive to my feedback? Is my  feedback incorporated into the counselling work that we do together? Remember that the way in which your feedback is expressed also plays a role in terms of how well it is received! Communicating assertively always goes further than aggressive or blaming statements.

Worldview – This may seem like a strange point but for some of us, it’s key.  For example, you may value your meditation practice and want a counsellor who meditates as well. Or, if you feel that meditation is not compatible with your religious beliefs, you probably won’t want a counsellor who meditates!

Convenience – Is the counsellor’s office convenient to where I live or work? Does the therapist have office hours that are compatible with my schedule? What is their availability like? Am I able to wait, if I think that the counsellor is right for me but is not immediately available, or do I need to see someone right away?

Credentials – As I’ve written in a past article, it can be difficult to understand credentials and what they mean.  Typically, it’s good to look for someone with graduate training in counselling. But the person’s designation may be important for another reason: if you have extended health coverage for counselling, through your employer, this could affect whether or not counselling is an affordable option for you.

In Conclusion…

And when all factors are considered, what does your intuition say? Reflecting and checking in with yourself for the final say is critical.